Improving Care Quality, Reducing Cost Requires ‘Cultural Shift’

Technological advances like cutting-edge EHRs and fully-functioning health information exchanges (HIEs) will only get physicians so far when it comes to health reform initiatives which stress improved quality at reduced costs.

In order to be successful in such programs, physicians will also need to undergo a cultural shift in the way they approach medicine.

This was a common theme that emerged during the inaugural Care Innovations Summit in Washington, D.C., held January 26, and initiated to facilitate dialogue and drive action towards the “three-part aim”: better health, improved quality, and lower cost, according to meeting organizers.

During the session “Care Delivery/Primary Care Innovation Case Study,” leaders at various ground-breaking primary-care organizations spoke about how their healthcare systems are working to achieve that triple aim.

Panelist and physician Christopher Chen is chief executive officer of ChenMed, a healthcare system which treats moderate- to low-income seniors with chronic conditions in 13 medical centers throughout the Southeast. He said his organization uses cutting-edge technology to improve quality and cost of care.

That technology includes a customized EHR and a wallet-sized “life card” (an ID card) that is distributed to each patient. The card provides easy access to patient information, including a copy of a patient’s most recent EKG printed directly onto the back of the card. This is especially useful during emergencies, Chen said.

The technology is impressive. But Chen said the organization’s successful track record - which includes reduced hospital admission and readmission rates and high patient satisfaction scores - is also very much due to the “culture” at the health system.

That culture, Chen explained, encourages physicians to focus more on patient care than volume of services. ChenMed operates under a full-risk reimbursement model, and as a result, physicians are not tied to the demands required of them by traditional fee-for-service.

At ChenMed, Chen said, physicians can focus more on “outcomes,” than “transactions.”

And he said when recruiting physicians, they are told, “We’re going to allow you to practice medicine that you thought you would be practicing when you graduated from medical school.”
The culture is also one which stresses care coordination, accountability, and patient compliance.

ChenMed physicians participate in weekly meetings to discuss patient outcomes. They also utilize various avenues to increase patient compliance, such as providing transportation to the healthcare systems and providing prescription medicine directly on-site.

Physician Lonny Reisman, chief medical officer at Aetna and another panelist during the session, said encouraging patient compliance is essential to improving quality of care at reduced cost. But he noted, it’s very difficult to successfully get patients on board.

“I don’t know that we’ve gotten to the root issue of getting people to care more about their well-being,” he said. Until we do that, “we’re not going to get to where we want to be.”

The summit was co-hosted by the Center for Medicare & Medicaid Innovation, the Office of the National Coordinator at HHS, The West Wireless Health Institute, and Health Affairs. Archived content will be available shortly.